Shooting ourselves in the foot

Published: Sunday, June 30, 2013 at 4:30 a.m.

Last Modified: Friday, June 28, 2013 at 6:08 p.m.

Our former congressman, conservative Republican Charles Taylor of Brevard, was fond of saying government could “mess up a one-car funeral.” Seeming to prove this point is the mess created for hospitals large and small, including our own Pardee Hospital, by the collective actions of the Obama administration, congressional Democrats, the U.S. Supreme Court, Gov. Pat McCrory and GOP leaders in the N.C. General Assembly.

Pardee may lose $13.76 million next year as a result of federal and state budget cuts, CEO Jay Kirby told the hospital’s board last week. That includes a loss of $1.13 million from the federal sequestration that began April 1, $4.44 million in cuts due to federal health care reform and an expected $8.2 million from state budget cuts.

The $4.44 million in cuts projected under the federal Affordable Care Act would have been more than offset by $6.62 million the hospital would have received through Medicaid if North Carolina had joined other states in expanding the health care program for low-income people. But Gov. McCrory and state lawmakers decided not to expand Medicaid, saying it made no sense to enlarge a system that lost $330 million in cost overruns last year.

Pardee, like many hospitals, was expecting to see a higher percentage of Medicaid patients and more funding through expanded Medicaid. If North Carolina remains among the 14 states that have so far rejected expanding Medicaid, costs for the hospital over the long term will be much higher than the $6.62 million the hospital stands to lose in the coming year.

Cuts to Medicaid under the Affordable Care Act are expected to cost the hospital $54 million over 10 years. If the hospital can’t recoup those funds over the next decade, it will have a hard time staying financially afloat, Kirby said earlier this year.

N.C. Sen. Tom Apodaca, R-Hendersonville, counters: “I don’t know how they can project a loss on something they never had.” He has a point, but it doesn’t change the math with which the hospital will have to deal.

Apodaca is among GOP leaders who fought against expanding Medicaid in a quixotic quest to slay the Obamacare beast. They hope if enough states refuse to expand Medicaid, they can halt or force fundamental changes to health care reform.

There’s one big problem with that line of thinking though: Obamacare, the Affordable Care Act — whatever you want to call it — is the law of the land. And states that reject Medicaid expansion are putting themselves, their businesses and their residents at a competitive disadvantage to states that are moving forward to expand Medicaid.

Health care reform was devised under the premise that all states would expand Medicaid to cover residents earning up to 138 percent of poverty level. Many Republicans view this as a vast expansion of government largess and dependency. But other Republican governors who opposed Obamacare in Arizona, Ohio, Florida and New Jersey have decided to accept Medicaid expansion and the federal dollars that come with it.

The federal government has pledged to pay all costs for three years and 90 percent thereafter for states that expand Medicaid. In North Carolina, the expansion would cost the state an estimated $850 million the first six years but would bring in $16 billion.

The big picture impact of those figures is illustrated in a new report by the RAND Corp., a nonprofit research organization. The report found that the 14 states with governors opposed to expanding Medicaid collectively stand to lose $8.4 billion a year. What’s more, the report predicts these states will end up paying an additional $1 billion in 2016 to cover increased levels of “uncompensated care” — the kind hospitals like Pardee provide to uninsured residents. Worst of all from a human standpoint, 3.6 million people may be left without health care coverage, including an estimated 500,000 in North Carolina.

GOP leaders say the inefficiency of the state’s Medicaid system is sucking money out of state government and driving budget cuts to state agencies and the UNC system. Gov. McCrory has left the door open to expanding Medicaid once this “broken” system is fixed.

State leaders should get with it and reform Medicaid, then reverse the blunder they made in rejecting expansion. Our health care system has enough problems as it is without having to cope with a massive self-inflicted wound.

<p>Our former congressman, conservative Republican Charles Taylor of Brevard, was fond of saying government could mess up a one-car funeral. Seeming to prove this point is the mess created for hospitals large and small, including our own Pardee Hospital, by the collective actions of the Obama administration, congressional Democrats, the U.S. Supreme Court, Gov. Pat McCrory and GOP leaders in the N.C. General Assembly.</p><p>Pardee may lose $13.76 million next year as a result of federal and state budget cuts, CEO Jay Kirby told the hospital’s board last week. That includes a loss of $1.13 million from the federal sequestration that began April 1, $4.44 million in cuts due to federal health care reform and an expected $8.2 million from state budget cuts.</p><p>The $4.44 million in cuts projected under the federal Affordable Care Act would have been more than offset by $6.62 million the hospital would have received through Medicaid if North Carolina had joined other states in expanding the health care program for low-income people. But Gov. McCrory and state lawmakers decided not to expand Medicaid, saying it made no sense to enlarge a system that lost $330 million in cost overruns last year.</p><p>Pardee, like many hospitals, was expecting to see a higher percentage of Medicaid patients and more funding through expanded Medicaid. If North Carolina remains among the 14 states that have so far rejected expanding Medicaid, costs for the hospital over the long term will be much higher than the $6.62 million the hospital stands to lose in the coming year.</p><p>Cuts to Medicaid under the Affordable Care Act are expected to cost the hospital $54 million over 10 years. If the hospital can’t recoup those funds over the next decade, it will have a hard time staying financially afloat, Kirby said earlier this year.</p><p>N.C. Sen. Tom Apodaca, R-Hendersonville, counters: I don’t know how they can project a loss on something they never had. He has a point, but it doesn’t change the math with which the hospital will have to deal.</p><p>Apodaca is among GOP leaders who fought against expanding Medicaid in a quixotic quest to slay the Obamacare beast. They hope if enough states refuse to expand Medicaid, they can halt or force fundamental changes to health care reform.</p><p>There’s one big problem with that line of thinking though: Obamacare, the Affordable Care Act  whatever you want to call it  is the law of the land. And states that reject Medicaid expansion are putting themselves, their businesses and their residents at a competitive disadvantage to states that are moving forward to expand Medicaid.</p><p>Health care reform was devised under the premise that all states would expand Medicaid to cover residents earning up to 138 percent of poverty level. Many Republicans view this as a vast expansion of government largess and dependency. But other Republican governors who opposed Obamacare in Arizona, Ohio, Florida and New Jersey have decided to accept Medicaid expansion and the federal dollars that come with it.</p><p>The federal government has pledged to pay all costs for three years and 90 percent thereafter for states that expand Medicaid. In North Carolina, the expansion would cost the state an estimated $850 million the first six years but would bring in $16 billion.</p><p>The big picture impact of those figures is illustrated in a new report by the RAND Corp., a nonprofit research organization. The report found that the 14 states with governors opposed to expanding Medicaid collectively stand to lose $8.4 billion a year. What’s more, the report predicts these states will end up paying an additional $1 billion in 2016 to cover increased levels of uncompensated care  the kind hospitals like Pardee provide to uninsured residents. Worst of all from a human standpoint, 3.6 million people may be left without health care coverage, including an estimated 500,000 in North Carolina.</p><p>GOP leaders say the inefficiency of the state’s Medicaid system is sucking money out of state government and driving budget cuts to state agencies and the UNC system. Gov. McCrory has left the door open to expanding Medicaid once this broken system is fixed.</p><p>State leaders should get with it and reform Medicaid, then reverse the blunder they made in rejecting expansion. Our health care system has enough problems as it is without having to cope with a massive self-inflicted wound.</p>